Does Anger Management Work for Disruptive Doctors?

A recent Washington Post/Kaiser Health Newsstory about anger management led with an anecdote about a surgeon who broke a scrub tech’s finger by slamming down an improperly loaded instrument. The surgeon was suspended for 2 weeks and had to take an anger management course, which seems like a mighty small penalty for what could be described as assault.

But the story had to go where many such tales seem to go these days.

Here’s a quote: “Experts estimate that 3 to 5 percent of physicians engage in such behavior, berating nurses who call them in the middle of the night about a patient, flinging scalpels at trainees who aren’t moving fast enough, demeaning co-workers they consider incompetent or cutting off patients who ask a lot of questions.”

Demeaning co-workers and berating nurses who call in the middle of the night? Yes, these things unfortunately do occur. But “flinging scalpels at trainees”? Sorry, I don’t think so. But of course, exaggeration is a common feature of articles about doctors, especially if the story wants to portray us in a negative way.

I was a surgical chairman for many years. I know all about disruptive doctors. In a recent blog, I even admitted to throwing an instrument myself once when I was a young and headstrong resident.

A link in the story goes to a full text paper on disruptive behavior in the Journal of Medical Regulation (who knew there was such a journal?). The author points out that isolated episodes of what some might consider bad behavior can happen, but unless there is a pattern or the incident was egregious, doctors should not be labeled as disruptive.

There are many problems with disciplining disruptive physicians. The article addressed a few of them.

Here are a couple that weren’t mentioned.

The disruptive doctor may be a busy surgeon or big admitter of patients. This puts the hospital in a bind, especially if there are other hospitals nearby. The doctor can and will threaten to take his patients across town.

Or the bad actor may be the only physician in a critically important specialty on staff.

These situations give physician miscreants leverage, which tends to mitigate the punishment meted out—analogous to the way pampered athletes and movie stars are treated when they commit crimes.

I have first-hand experience with this, having dealt with disruptive surgeons in the past. What I wanted to do and what the hospital administration would permit me to do weren’t always the same. By the way, behavior modification programs rarely result in permanent cures. A middle-aged surgical ogre is not likely to become Prince Charming after 2 weeks of anger management.

So the issue is not as straightforward as it seems.

By the way, just to show how far toward equality we have come, that surgeon who broke the scrub tech’s finger was a woman.

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last two years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 800 page views per day, and he has over 5000 followers on Twitter.

About The Author

SkepticalScalpel

Skeptical Scalpel

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last two years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 800 page views per day, and he has over 5000 followers on Twitter.

I think the disruptive surgeon would consider it punitive because spending a week away from her practice would cost her a lot of money. A week off for a vacation is one thing. Going to a course you don’t want to attend for a week is another.

I believe that my firm, Anderson & Anderson, APC is the only program in the nation for “disruptive physicians” that uses a Pre and Post Test. In the very near future, we will have a researcher take a look at our data based and report our success with our 6 month coaching programs for this population.

Reuben, I’m afraid you have made a generalization that the “majority of disruptive physicians are surgeons.” I’m not aware of any research supporting that statement. You also incorrectly assume that I trained surgeons to be disruptive. I did not permit bullying of residents or students. Some programs may still do it that way, but not mine.

Almost didn’t comment. I would not be surprised if the majority of disruptive physicians are surgeons. Your training programs and overall bullying attitude has perpetuated these attitudes. The medical world has changed and will not tolerate this behavior, but the surgeons you trained find it hard to change. Plenty of causes for both medical and surgical colleagues, but don’t underestimate the value of this point.

Another issue that leads to anger and discordant interactions among physicians is stress and burnout, which I believe ARE fixable, although probably not with a two week course. Given the epidemic of stress and burnout among physicians today, I think it’s hard to discuss this topic without acknowledging its role. Sure, there are the perfectionistic sociopaths in positions of power (we all know them), but they’re not the only offenders.

If you are a physician with too many responsibilities, taking too much call, and working in a hostile environment without enough support or backup, it becomes really really hard to be nice to people. I’ve been there. Granted, I never threw anything, but I certainly did snap at a few people who called me at 3 am. And honestly, doing so was completely out of character for me, I’m not an inherently angry or short-fused person. And I’m certainly not a fancy specialist drunk on power (more like the opposite). I was just overwhelmed and burned out. For me, it took personal tragedy to get me out of a really tough situation, but in general, a supportive environment can make a world of difference.

As you (and the original article) point out, the punitive approach to managing “disruptive doctors” is often less than effective, but it’s worth mentioning that being compassionate, supporting our colleagues, and taking steps to recognize and address burnout can make a world of difference as well.

Anonymous, I am sorry about the delay in responding. You make some good points. Even the most congenial among us can experience stress and burnout. That is why it is important to note whether an incident is isolated or part of a pattern.

There’s a small number of “disruptive doctors” who get disciplined because they find bad medical care intolerable and sloppiness infuriates them. Sometimes “keeping the peace” means a status quo that harms patients.

That’s true, but many times the fine line between demanding excellence and harassment is crossed. One of the characteristics of a disruptive physician is her belief that no one can live up to her lofty standards.